Is that groin rash cancer ??

                                  Is that groin rash cancer ??


           A few years ago one of my male patients presented with a groin rash of

several months duration which was unresponsive to various topical antifungals and

topical corticosteroids prescribed by his health care practitioner.

            The rash was red and scaly encompassing both his groin and extending

to his scrotal areas. There was associated itching and burning at times.

           The most important clue here was the fact that the rash had been

chronically unresponsive to the above measures.

            And,I immediately suspected a condition called extramammary Paget's

disease (EMPD) which fortunately is  a rare cancerous condition of apocrine-

gland bearing sites.

            Two types of EMPD have been described: the primary type thought to arise

from a stem cell within genital skin and not associated with an underlying internal

malignancy involving the rectum and/or other internal body areas. However, it is

still a carcinoma of the skin and needs to be treated.

           Secondary EMPD  is the more dangerous type since it is associated with

an underlying adnexal  adenocarcinoma or an  underlying visceral (internal)

cancer and is the same as mammary Paget's disease of the nipple.

          I referred my patient to a general surgeon for a deep excisional skin

biopsy which confirmed my clinical suspicions. The presence of a cellular

protein called cytokeratin 20 helps to differentiate between the primary and

secondary types of EMPD.

         In addition, the presence of a gene called HER-2  in the biopsy specimen

may indicate a high risk for spread to lymph nodes and the need to follow this

patient very diligently.

          EMPD most frequently involves the vulva in women,the perianal area,perineum,

scrotum,penis, and armpits. Treatment includes wide surgical excision,radiation

therapy and several topical agents.

         

Brief Overview of Lasers in Dermatology

                     Lasers basically emit  bright beams of light energy that is converted

to heat energy in the skin. And,it is this heat energy that performs the many

dermatological functions of lasers.

                    These functions include treating spider veins,dilated blood vessels,

the redness of rosacea,scars,stretch marks, liver spots,freckles,tattoos, and benign dark

spots on the skin such as age spots.

                    In addition,lasers help to remove unwanted body hair and stimulate

collagen production to eliminate fine lines,skin creases,and wrinkles.

                   In my opinion,the birth of fractional resurfacing lasers  is one

of the most exciting developments in laser therapy since these lasers literally

treat only a "fraction" of the skin at a time and, therefore, dramatically reduce

the incidence of side effects such as scarring,pigment changes, and infection.

                 Future possible therapeutic uses for lasers include  enhancing

the percutaneous delivery of drugs and also healing chronic wounds  and ulcers.

Psoriasis: more than a skin disease ?

            A recent study implicates Psoriasis with a 70 % increased likelihood  of

developing non-alcoholic fatty liver disease (NAFLD) which is the most

common  form of chronic liver disease in Western countries.
         
           In addition,Psoriasis patients with NAFLD  were also 60 %

more likely to have the severe form of NAFLD.

           The most distinguishing feature of NAFLD is the accumulation of

triglycerides(a  type of lipid or fat) in the liver cells called hepatocytes.

           Risk factors for NAFLD besides Psoriasis include diabetes,hypertension,

obesity,a sedentary lifestyle,smoking and a poor diet.

          Besides advising my patients with Psoriasis about the increased

cardiovascular risks (see my earlier post on "the heartbreak of Psoriasis"),

I shall now inform them of the non-alcoholic fatty liver disease risk and

again recommend regular checkups with their healthcare practitioner.

Disclaimer

                                         Disclaimer:


             Please note that the information on dermatologyandmedical.blogspot.com

is intended for educational purposes only and is not intended to treat,cure, or diagnose

your condition,nor is the information on this site to be used in lieu of consulting

your physician or other qualified health care provider.

                            These popular meds can cause sunburn:


         The following list of medications is certainly not all-inclusive since

many different classes of prescription and over-the-counter drugs can

make the skin more sensitive to  ultraviolet rays.

        Some of the more well-known medications are:

       Antibiotics:  tetracycline,doxycycline hyclate(not the smaller dose

brand known as Oracea), and sulfa-containing  drugs such as trimethoprim/

sulfamethoxazole

       Arthritis drugs: Ibuprofen, naproxen

      Blood pressure/"water pill" drugs:  hydrochlorthiazide(more a blood pressure

drug than a water pill),furosemide(more a water pill than a blood pressure drug),

These two both contain sulfa (a photosensitized)

       A recent study showed that  the calcium channel blocker nifedipine

and the ACE inhibitor lisinopril increased sun sensitivity  and made users

more likely to develop lip cancer.

     Diabetes drugs: glipizide (contains sulfa),glyburide(contains sulfa),and

chlorpropamide which also contains sulfa

   

   The bottom line with all of these is that the benefit of these drugs

certainly outweighs the possible sun-sensitivity side effect that can

be offset with the proper use of sunscreens and sun-exposure.

And they should be discontinued only with the consent of the

health care practitioner prescribing them.


   

                                       Merkel Cell Carcinoma(MCC)-a blood test to predict spread


                      In the 50 % of patients who produce antibodies to the MCC polyomavirus

oncoprotein at diagnosis,there is now a blood test to measure these antibodies upon

follow up visits .

                     Since about 40 % of  MCC's recur ,this blood test can be an early  way

to detect Metastasis (spreading) in otherwise asypmtomatic patients who have

these antibodies-long before these "mets" show up on diagnostic  testing.

                                                       Skin Cancer:Not just the Sun



            Most of us are aware that excessive ultraviolet radiation from the

sun can cause skin cancer.

            However,there are other potential causes of skin cancer and these

include:

           1)  X-ray  irradiation

           2)non-healing and chronic  skin sores and ulcerations. I always

suspect a type of skin cancer called squamous cell carcinoma  in

my patients with these problems.

          3)vaccination marks  and scar tissue

          4)arsenic in well water (more likely near sod and turf farms))

          5)both internal cancer and the radiation and/or chemotherapy

used for treatment: both the cancer and the treatment modalities can

suppress the immune system making one more likely to have skin

cancer

                                            Watch out for this one :


                                            Merkel Cell Carcinoma


                    Merkel cell carcinoma (MCC) a is a relatively uncommon but highly aggressive

skin cancer. Many cases have been tied to infection with a virus called "polyomavirus."

                    The good news about  MCC is that it is rare.The bad news is that unlike

other skin cancers  including malignant melanoma it can be very difficult to diagnose

clinically.Although it can be  a red or blue bump,(almost like a pimple),it can also

appear as a small flesh colored  elevation. It can range in size from one-quarter inch

(the size of a pencil eraser) to more than 2 inches.

                   About one half of MCC's originate on the sun-exposed head and neck,

about one-third on the legs and about one-sixth on the arms.Sometimes no anatomical

or primary site of origin can be identified.

                  As with any cancer,whether internal or skin,early detection and treatment

before it has chance to spread markedly increases the survival rate.

                  Again, report any changes in size,shape,color or evolution of

of your skin and body areas to your medical practitioner  and get regular

skin and physical examinations.

                 

                   

Beware of fillers for forehead lines

               Several cases have been reported connecting the use of fillers such

as hyaluronic acid (botox is not a filler) with subsequent vision problems

in patients including blindness.


             The mechanism of action appears to be embolization (spread)

of the filler particles via the rich forehead blood supply to the opthalmic

and retinal blood vessels feeding the eye(s)


            Also,keep in mind that  wrinkle fillers such as hyaluronic acid are

not  FDA approved for forehead lines.

                           

                                          The "Heartbreak" of Psoriasis:


                   Years ago we often  commented about the psychological  pain of psoriasis

and called it the "heartbreak of psoriasis."    Well, today I make it a point to tell my patients

with psoriasis that recent research shows an increase  of cardiovascular problems including

coronary artery disease,high blood pressure,and diabetes especially in those with

moderate to severe psoriasis.

                   And,I urge them to get regular checkups with their  medical practitioner

to monitor for these problems.